Epidemiological study of variations in beta-lactam antibiotic susceptibility of Pseudomonas aeruginosa in two intensive care units

被引:22
作者
Cailleaux, V
Mulin, B
Capellier, G
Julliot, MC
Thouverez, M
Talon, D
机构
[1] HOP JEAN MINJOZ,LAB BACTERIOL HYG,F-25030 BESANCON,FRANCE
[2] HOP JEAN MINJOZ,FAC MED,SERV REANIMAT,F-25030 BESANCON,FRANCE
关键词
Pseudomonas aeruginosa; beta-lactam susceptibility; epidemiological study;
D O I
10.1016/S0195-6701(97)90250-4
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
A six-month prospective study was carried out in the medical and surgical intensive care units (ICUs) at Besancon University Hospital to assess the frequency and risk factors for beta-lactam-resistant isolates of Pseudomonas aeruginosa. Clinical samples were screened for P. aeruginosa, and four antibiograms were distinguished using imipenem and ceftazidime, namely: fully susceptible (SS), imipenem-resistant (RS), ceftazidime-resistant (SR), and resistant to both (RR). DraI restriction fragment length polymorphism of isolates from different patients or with different resistance patterns but the same serotype was assessed by pulsed-field gel electrophoresis. One hundred and twenty-one isolates were obtained from 50 of 281 patients, 60.3% were fully susceptible. 19.8% imipenem-resistant, 13.2% ceftazidime-resistant, and 6.6% resistant to both. Antibiotic-resistance was independent of serotype. Twenty-two of 32 imipenem-resistant isolates from six patients were of the same DNA type, and six other isolates from four patients were of a second DNA type. On only one occasion did a clonally defined strain develop imipenem resistance. By contrast ceftazidime-resistant strains had differing DNA types, but had been originally ceftazidime-susceptible in seven of 12 patients. Reversion of imipenem resistant strains to susceptibility occurred in one patient, and of ceftazidime-resistant strains in five patients. Case-control studies identified prier antibiotic therapy as a risk factor in colonization with resistant strains. Resistance to imipenem followed imipenem therapy, and resistance to ceftazidime followed use of weakly anti-pseudomonal beta-lactam antibiotics. The major route elf spread of imipenem-resistant strains was cross-colonization. Thus, assuming appropriate isolation, a carbapenem should be preferred to an extended-spectrum cephalosporin to treat pseudomonas infections in ICU patients.
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页码:217 / 224
页数:8
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